Healthcare Provider Details

I. General information

NPI: 1598489692
Provider Name (Legal Business Name): JOAO MANOEL DA SILVEIRA LARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N EDWARD ST STE 3200
DECATUR IL
62526-4192
US

IV. Provider business mailing address

2300 N EDWARD ST STE 3200
DECATUR IL
62526-4192
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-3660
  • Fax: 217-876-3665
Mailing address:
  • Phone: 217-876-3660
  • Fax: 217-876-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT227003
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036173646
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: